Life’s Simple 7 tied to lowered PAD risk in long-term study

Adherence to the American Heart Association’s Life’s Simple 7 is associated with lower incidence of peripheral artery disease and less decline in ankle brachial index, according to the results of a retrospective analysis of patients in the Multi-Ethnic Study of Atherosclerosis (MESA) trial.

“These results support the use of LS7 to prevent PAD and decline in ABI in multiple racial/ethnic groups,” according to Jonathan T. Unkart, MD, of the department of medicine and public health, University of California, San Diego, and his colleagues.

MESA recruited 6,814 men and women aged 45-84 years who were free of clinical cardiovascular disease. The cohort comprised 53% women and had the following racial/ethnic composition: 38% non-Hispanic white; 28% African American; 23% Hispanic, and 11% Asian. MESA consisted of six exams, with the baseline exam occurring from 2000 to 2002, including assessment of all LS7 components and PAD assessment using ABI calculated on both left and right sides. The final exam was performed from 2010 to 2012.

As background, the metrics for Life’s Simple 7 consist of total cholesterol, blood pressure, blood glucose, smoking status, body mass index, physical activity, and adherence to a healthy diet score. Each element can be scored 2 points for optimum, 1 for average, and 0 for inadequate. The investigators assessed overall LS7 scores on a continuous 0-14 scale, as well as the overall categorical indications of inadequate, average, and optimum. Cox proportional hazard models were used to assess the association of individual LS7 components by overall LS7 with incident PAD, according to the researchers.

Interactions of race/ethnicity by LS7 score were assessed on a multiplicative scale for both incident PAD and decline in ABI outcomes, adjusted for age, sex, education, and income (Am J Prev Med. 2019;56:262-70).

A total of 5,529 participants had complete LS7 information and met inclusion criteria to assess incident PAD. Over a median follow-up of 9.2 years, 251 (4.5%) participants developed incident PAD and 419 (9.8%) participants had a decline of at least 0.15 in ABI. In addition, each point higher on the continuous LS7 scale was associated with 0.94-fold lower odds of decline in ABI (odds ratio, 0.94; 95% confidence interval, 0.87-0.97; P =.003).

Each point higher on the continuous LS7 scale was associated with a 17% lower rate of incident PAD (HR, 0.83; 95% CI, 0.78-0.88; P less than .001), according to the researchers.

 

The study showed that there was a significant prospective association between LS7 score and incident PAD in African Americans, Hispanics, and non-Hispanic whites. Although the association was not statistically significant for the Chinese Americans in MESA, this was likely because of the low number of incident PAD cases (only 18) in this group, according to the authors.

Analysis by individual LS7 components showed that more optimal levels of smoking, physical activity, glucose, and blood pressure were significantly associated with lower rates of incident PAD. Similarly, after adjustment for age, sex, race/ethnicity, income, education, and baseline ABI, more optimal levels of smoking, and glucose were significantly associated with lower odds of decline. These results for the decline in ABI did not appear to differ across race/ethnicity, according to Dr. Unkart and his colleagues.

In contrast, BMI, diet, and cholesterol were not associated with incident PAD or decline in ABI.

“Higher scores on the AHA LS7 were associated with lower incident PAD and less decline in ABI. Preventive measures targeting LS7 components could assist with reducing PAD-related morbidity and mortality,” the researchers concluded.

The work was supported by the National, Heart, Lung, and Blood Institute. Dr. Unkart and his colleagues reported that they had no disclosures.

mlesney@mdedge.com

SOURCE: Unkart JT et al. Am J Prev Med 2019;56:262-270.

Adherence to the American Heart Association’s Life’s Simple 7 is associated with lower incidence of peripheral artery disease and less decline in ankle brachial index, according to the results of a retrospective analysis of patients in the Multi-Ethnic Study of Atherosclerosis (MESA) trial.

“These results support the use of LS7 to prevent PAD and decline in ABI in multiple racial/ethnic groups,” according to Jonathan T. Unkart, MD, of the department of medicine and public health, University of California, San Diego, and his colleagues.

MESA recruited 6,814 men and women aged 45-84 years who were free of clinical cardiovascular disease. The cohort comprised 53% women and had the following racial/ethnic composition: 38% non-Hispanic white; 28% African American; 23% Hispanic, and 11% Asian. MESA consisted of six exams, with the baseline exam occurring from 2000 to 2002, including assessment of all LS7 components and PAD assessment using ABI calculated on both left and right sides. The final exam was performed from 2010 to 2012.

As background, the metrics for Life’s Simple 7 consist of total cholesterol, blood pressure, blood glucose, smoking status, body mass index, physical activity, and adherence to a healthy diet score. Each element can be scored 2 points for optimum, 1 for average, and 0 for inadequate. The investigators assessed overall LS7 scores on a continuous 0-14 scale, as well as the overall categorical indications of inadequate, average, and optimum. Cox proportional hazard models were used to assess the association of individual LS7 components by overall LS7 with incident PAD, according to the researchers.

Interactions of race/ethnicity by LS7 score were assessed on a multiplicative scale for both incident PAD and decline in ABI outcomes, adjusted for age, sex, education, and income (Am J Prev Med. 2019;56:262-70).

A total of 5,529 participants had complete LS7 information and met inclusion criteria to assess incident PAD. Over a median follow-up of 9.2 years, 251 (4.5%) participants developed incident PAD and 419 (9.8%) participants had a decline of at least 0.15 in ABI. In addition, each point higher on the continuous LS7 scale was associated with 0.94-fold lower odds of decline in ABI (odds ratio, 0.94; 95% confidence interval, 0.87-0.97; P =.003).

Each point higher on the continuous LS7 scale was associated with a 17% lower rate of incident PAD (HR, 0.83; 95% CI, 0.78-0.88; P less than .001), according to the researchers.

 

The study showed that there was a significant prospective association between LS7 score and incident PAD in African Americans, Hispanics, and non-Hispanic whites. Although the association was not statistically significant for the Chinese Americans in MESA, this was likely because of the low number of incident PAD cases (only 18) in this group, according to the authors.

Analysis by individual LS7 components showed that more optimal levels of smoking, physical activity, glucose, and blood pressure were significantly associated with lower rates of incident PAD. Similarly, after adjustment for age, sex, race/ethnicity, income, education, and baseline ABI, more optimal levels of smoking, and glucose were significantly associated with lower odds of decline. These results for the decline in ABI did not appear to differ across race/ethnicity, according to Dr. Unkart and his colleagues.

In contrast, BMI, diet, and cholesterol were not associated with incident PAD or decline in ABI.

“Higher scores on the AHA LS7 were associated with lower incident PAD and less decline in ABI. Preventive measures targeting LS7 components could assist with reducing PAD-related morbidity and mortality,” the researchers concluded.

The work was supported by the National, Heart, Lung, and Blood Institute. Dr. Unkart and his colleagues reported that they had no disclosures.

mlesney@mdedge.com

SOURCE: Unkart JT et al. Am J Prev Med 2019;56:262-270.

Adherence to the American Heart Association’s Life’s Simple 7 is associated with lower incidence of peripheral artery disease and less decline in ankle brachial index, according to the results of a retrospective analysis of patients in the Multi-Ethnic Study of Atherosclerosis (MESA) trial.

“These results support the use of LS7 to prevent PAD and decline in ABI in multiple racial/ethnic groups,” according to Jonathan T. Unkart, MD, of the department of medicine and public health, University of California, San Diego, and his colleagues.

MESA recruited 6,814 men and women aged 45-84 years who were free of clinical cardiovascular disease. The cohort comprised 53% women and had the following racial/ethnic composition: 38% non-Hispanic white; 28% African American; 23% Hispanic, and 11% Asian. MESA consisted of six exams, with the baseline exam occurring from 2000 to 2002, including assessment of all LS7 components and PAD assessment using ABI calculated on both left and right sides. The final exam was performed from 2010 to 2012.

As background, the metrics for Life’s Simple 7 consist of total cholesterol, blood pressure, blood glucose, smoking status, body mass index, physical activity, and adherence to a healthy diet score. Each element can be scored 2 points for optimum, 1 for average, and 0 for inadequate. The investigators assessed overall LS7 scores on a continuous 0-14 scale, as well as the overall categorical indications of inadequate, average, and optimum. Cox proportional hazard models were used to assess the association of individual LS7 components by overall LS7 with incident PAD, according to the researchers.

Interactions of race/ethnicity by LS7 score were assessed on a multiplicative scale for both incident PAD and decline in ABI outcomes, adjusted for age, sex, education, and income (Am J Prev Med. 2019;56:262-70).

A total of 5,529 participants had complete LS7 information and met inclusion criteria to assess incident PAD. Over a median follow-up of 9.2 years, 251 (4.5%) participants developed incident PAD and 419 (9.8%) participants had a decline of at least 0.15 in ABI. In addition, each point higher on the continuous LS7 scale was associated with 0.94-fold lower odds of decline in ABI (odds ratio, 0.94; 95% confidence interval, 0.87-0.97; P =.003).

Each point higher on the continuous LS7 scale was associated with a 17% lower rate of incident PAD (HR, 0.83; 95% CI, 0.78-0.88; P less than .001), according to the researchers.

 

The study showed that there was a significant prospective association between LS7 score and incident PAD in African Americans, Hispanics, and non-Hispanic whites. Although the association was not statistically significant for the Chinese Americans in MESA, this was likely because of the low number of incident PAD cases (only 18) in this group, according to the authors.

Analysis by individual LS7 components showed that more optimal levels of smoking, physical activity, glucose, and blood pressure were significantly associated with lower rates of incident PAD. Similarly, after adjustment for age, sex, race/ethnicity, income, education, and baseline ABI, more optimal levels of smoking, and glucose were significantly associated with lower odds of decline. These results for the decline in ABI did not appear to differ across race/ethnicity, according to Dr. Unkart and his colleagues.

In contrast, BMI, diet, and cholesterol were not associated with incident PAD or decline in ABI.

“Higher scores on the AHA LS7 were associated with lower incident PAD and less decline in ABI. Preventive measures targeting LS7 components could assist with reducing PAD-related morbidity and mortality,” the researchers concluded.

The work was supported by the National, Heart, Lung, and Blood Institute. Dr. Unkart and his colleagues reported that they had no disclosures.

mlesney@mdedge.com

SOURCE: Unkart JT et al. Am J Prev Med 2019;56:262-270.